Maximum Allowable Cost Information

As we've previously written, this legislation has some specific requirements for pharmacy benefit management companies to follow:

• A PBM cannot put a drug on a MAC list without meeting certain criteria.
• Sources utilized must be provided to the network pharmacy.
• The listing shall be readily available to the pharmacy.
• The list shall be reviewed and updated every seven business days.
• The PBM shall not include dispensing fees in MAC calculations.
• The PBM shall establish a process for appeal.

Other key provisions of the bill can be read in this short summary. During the legislative process, KPhA made it known to the legislature that there were no enforcement mechanisms in this legislation, hence no incentives for the PBMs to follow the law. Key legislators acknowledged that fact and told us that if PBMs did not follow the legislation that they would consider adding enforcement mechanisms during the next (2017) legislative session.

It is difficult for us to gauge how effective this legislation has been so far. KPhA has received information on shortcomings by the PBMs from only three pharmacies. We can evaluate the effectiveness of this important legislation only through data provided by you. If you feel that a PBM is not complying with the law, we have created a form to assist you in capturing data to show this fact. It is extremely important that data be provided, because data is the only means by which we can show a legal enforcement mechanism is necessary. Pharmacy Services Administrative Organizations (PSAO) in many cases are able to assist you in quickly and easily retrieving this data. Request that your PSAO provide you this data and forward it to KPhA. 

The forms that we have created are available as hyperlinks below. We also welcome data provided in a format created by your PSAO. Please be sure that there is no personally identifiable information submitted. The information captured by pharmacies and presented in these forms will help KPhA in the future if further legislative action needs to be taken.

Contact the KPhA office if you have any questions.

MAC Reporting Forms

MAC Reporting Form

MAC Printed Form

Excel Version 

Excel Version allows you to capture multiple issues on one form